Healthcare Provider Details

I. General information

NPI: 1699274589
Provider Name (Legal Business Name): AMIN ALI DELEON LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79-25 WINCHESTER BLVD
QUEENS VILLAGE NY
11427
US

IV. Provider business mailing address

79-25 WINCHESTER BLVD
QUEENS VILLAGE NY
11427
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-7500
  • Fax:
Mailing address:
  • Phone: 718-264-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number267382-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: